Re: FDA Panel Votes to Eliminate Vicodin and Percocet
Pain management, acute or chronic remains one of the biggest challenges to all health care teams. As nurses, we are taught that pain is an individual symptom and its assessment is based upon accepting a patient's communication of pain and its severity´-an ethical approach which respects patient rights. Alongside, privately, many health care team members still experience scepticism of a suspected *seeker* vis a vis genuine pain and suffering. This can affect our overall judgement and objectivity during pain assessment and subsequent Rx.
Causes of pain, the *memory* of pain occurring within the spinal cord triggers the chronicity and escalation of pain, where the memory of chronic pain can dictate its treatment and can lead to our frustration at how elusive good pain management can be. Ideally, anticipation of pain, accepting what the patient's judgement and initiating good pain management early on can effectively resolve certain causes of pain eg. post op. I have seen many fresh post op major surgery patients arrive in RR without a good post op pain managment Rx, sometimes based upon the patients inter operative condition or subsequent to unforseen events during surgery. Despite this, pain management must be initiated, and titrated according to the patient's condition.
Tylenol which is believed to act in conjunction with calcium channel pathways in the spinal cord is usually prescrbed as an adjuvant and should be not used over an extended time. I think that it should not be included as a compound with other narcotics. The real danger lies in its ease of availability as an OTC and its extra strength Rx. The lack of public education about tylenol, deadly allergy and its secondary and accumulative effects on the liver is a gap in community/consumer education and, in reality, has not been addressed. The issues of Vicodin and Percocet are useful in pain management and should be prescribed by pain management specialists.
Building patient trust and collaboration in pain management takes time, empathy and skilled clinical assessment. Banning a particular narcotic which may provide effective pain relief has no relation to the reality of the side effects of the adjuvant and again illustrates the need for on going education and training for MD's /pain management nursing specialists.
Nursing News